The data widely purporting to show the existence and heterosexual
transmission in Africa of a new syndrome caused by a retrovirus which
induces immune deficiency is critically evaluated. It is concluded that
both acquired immune deficiency (AID) and the symptoms and diseases
which constitute the clinical syndrome (S) are long standing in Africa,
affect both sexes equally and are caused by factors other than HIV. The
presence of positive HIV serology in Africans represents no more than
cross-reactivity caused by an abundance of antibodies induced by the
numerous infectious and parasitic diseases which are endemic in Africa,
that is, a positive HIV antibody test does not prove HIV infection.
Given the above, one would expect to find a high prevalence of "AIDS"
and "HIV" antibodies in Africa. This is not proof of heterosexual
transmission of either HIV or AIDS.

Introduction

Following the appearance in the West in the early 1980s of AIDS in
gay men, many European and American researchers looked for AIDS in
Africa. There were three reasons for this. One was Dr. Robert Gallo's
hypothesis that AIDS is caused by a retrovirus HTLV-I, or a similar
virus. (At the time it was known that Africans had a high prevalence of
positive HTLV-I serology). The other reasons were the high prevalence of
Kaposi's sarcoma (KS) in Africa, and the diagnosis of "AIDS" in a small
number of patients of African origin who were living in Europe. Yet,
there were so many problems with the HTLV-I theory of AIDS that by 1984
it had been abandoned, even by Gallo himself, and although KS was
practically non-existent in gay men before the AIDS era, KS has been
present in Africa since antiquity. Its characteristic clinical
appearances are described in the Ebers papyrus which dates from 1600
B.C. As for the AIDS cases described by Belgian doctors in the patients
of African descent, the doctors who reported these cases did not exclude
the possibility that AIDS has always been present in Africa (Clumeck et
al., 1984). Despite these facts, the claim that the cause of AIDS
everywhere, including Africa is HIV, has been overwhelmingly accepted.
In fact, AIDS in Africa became of such pivotal significance to the
HIV/AIDS theory that in 1990 nearly 600 "AIDS-related" studies were
conducted in Africa. Yet even up to 1994, "There have been few studies
of the impact of HIV-1 infection on mortality in Africa, and none for a
general rural population" (Mulder et al., 1994). In this widely
publicized report, which appeared in the Lancet, Mulder and his
colleagues tested blood samples from Ugandan rural subsistence farmers
for "HIV-1 antibodies at the Uganda Virus Research Institute". Of 9389
individuals tested, 4.8% were found to be positive. "Deaths were
ascertained over 2 years" and 198 were recorded. Of these 109 were in
seronegative individuals and 89 in seropositive individuals. Of the
latter, 73 were adults. In a commentary accompanying publication of this
study, researchers from the CDC wrote: "An ironic feature of this work
is that it does not require a belief that HIV is the cause of AIDS.
Rather, the study shows that the simple finding of antibodies against
HIV in an individual's serum predicts a likelihood of death within the
next several years far above that for a seronegative individual.
Although most reasonable observers do accept that HIV causes AIDS, even
sceptics cannot fail to acknowledge the high prevalence of antibody to
HIV in Africa. If there are any left who will not even accept that
antibody to HIV indicates infection with the virus, their explanation of
how HIV seropositivity leads to early death must be curious indeed"
(Dondero & Curran, 1994). In the following we present just such an
alternative explanation of this, and other published studies on the
"epidemic" of AIDS in sub-Saharan Africa. We leave it to the reader to
judge exactly how curious it is.

Acquired Immune Deficiency (AID)

AIDS researchers in Africa, including those from the CDC and WHO,
admit that immune deficiency in Africa has existed for a considerable
time and this has not been due to HIV. "Tuberculosis, protein calorie
malnutrition, and various parasitic diseases can all be associated with
depression of cellular immunity" (Piot et al., 1984). "A wide range of
prevalent [in Africa] protozoal and helminthic infections have been
reported to induce immunodeficiency" (Clumeck et al., 1984). "...among
healthy Africans resident in a non-AIDS area, the numbers of helper and
suppressor lymphocytes were the same in HTLV-III/LAV seropositive and
seronegative subjects..." (Biggar, 1986). "Africans are frequently
exposed, due to hygenic conditions and other factors, to a wide variety
of viruses, including CMV, EBV, hepatitis B virus, and HSV, all of which
are known to modulate the immune system...Furthermore, the Africans in
the present study are at an additional risk for immunologic alterations
since they are frequently afflicted with a wide variety of diseases,
such as malaria, trypanosomiasis, and filariasis, that are also known to
have a major effect on the immune system" [CMV=cytomegalovirus;
EBV=Epstein-Barr virus; HSV=herpes simplex virus] (Quinn et al.,
1987).

The Syndrome (S)

If AIDS in Africa is the same condition with the same cause as
anywhere else in the world then AIDS in Africa and AIDS in the West
should be identical. This is not the case and what is called AIDS in
Africa is almost unrecognizably different from AIDS in the West, so much
so that if African patients suddenly switched continents, very few
Africans would remain AIDS cases. This is due to the existence of
multiple AIDS definitions, one for Africa (the same for adults and
children), one for adults in North America, Europe and Australia, one
for children in these countries and one for Latin America. Unlike the
AIDS definition in the West, the WHO Bangui definition for Africa does
not require immunological (T4 lymphocyte cell or antibody) tests or a
specific disease diagnosis but consists largely of symptoms such as
weight loss, diarrhoea, cough and fever. For example, an African with
diarrhoea, fever and persistent cough for longer than one month is, by
definition, an AIDS case. However, the symptoms listed in the Bangui
definition (WHO, 1986) are common and non-specific manifestations of
many diseases which are endemic in Africa and were so long before the
AIDS era. This is accepted by some of the best known AIDS researchers
including those from Belgium, the WHO and the CDC. According to Jonathan
Mann, former director of the WHO Global AIDS program, and his
colleagues, "...recognition of pediatric AIDS is particularly difficult
in Kinshasha [Zaire], since many children have severe infant and
childhood diseases with similar manifestations (eg, weight loss, chronic
diarrhoea)" (Mann et al., 1986). Anthony Fauci, Director of the National
Institute of Allergy and Infectious Diseases in the United States,
discussing the AIDS definition in Africa states: "Well, of course it
will be less reliable (than that used in non-Third-World countries). One
typical example is what we call 'slim disease'. It's a wasting syndrome
seen in Africa. Now that wouldn't fall under any categorization of AIDS
by the standard empiric definition, but nevertheless, (slim disease) is
being considered AIDS in Africa" (AIDS Alert, January 1987). According
to Myron Essex on who's work speculations as to the African origin of
HIV is mainly based, "malnutrition and general lack of medical services
contributed to diarrhoea, tuberculosis, and other common African
diseases that signify AIDS" (New Scientist, 18th February
1988). In summary, although, the best known researchers of African AIDS
clearly accept that both AID and the AID syndrome (S) existed in Africa
long before the AIDS era and that they were caused by agents other than
HIV, the same researchers expect the world to accept that in Africa
there is a new disease, AIDS, caused by a new virus, HIV.

Antibody Tests for HIV

The evidence for the existence of HIV in Africa is based on the
random testing of Africans for the presence of HIV antibodies. The HIV
antibody tests rely on the presence or absence of reactions between
antibodies present in patients' blood and certain proteins which are
believed to be unique to HIV. Even if the proteins are proven to unique
to HIV, which at present is not the case, a positive test cannot be
considered proof of HIV infection. This is because non-HIV antibodies
can (and do, see below) react with the "HIV proteins" producing positive
tests in individuals who are not HIV infected. Because of this, before
the test is used to diagnose HIV infection the test's specificity must
be determined, one must determine how often false-positive tests occur.
For this one must:

1. Test a large number of patients, both AIDS and non-AIDS
patients.

2. Simultaneously perform tests for true HIV isolation.

3. Compare the antibody test results with the results of HIV
isolation, that is, use HIV as a gold standard for the antibody test.

A thorough search of the HIV antibody test literature fails to show a
single instance of the use of the above, the only scientifically valid
method of determining the specificity of the HIV (or any) antibody
tests. Indeed, comparisons between the published work on retrovirology
and the presently worldwide data on HIV reveals that no researcher has
yet met the requirements for an HIV gold standard. This is because the
phenomena collectively inferred as HIV (reverse transcriptase,
virus-like particles, "HIV antigens", and "HIV PCR"), are all
non-specific (Papadopulos-Eleopulos et al., 1993a, 1993b). The lack of a
gold standard has already been adduced by one of the best known HIV/AIDS
researchers, William Blattner: "One difficulty in assessing the
specificity and sensitivity of retrovirus assays is the absence of a
final 'gold standard'. In the absence of gold standards for both HTLV-I
and HIV-1, the true sensitivity and specificity for the detection of
viral antibodies remain imprecise" (Blattner, 1989). For some unknown
reason, HIV experts (such as Mulder) determine the specificity of the
HIV antibody tests by repeating an antibody test or a combination of
antibody tests an arbitrary number of times and use another antibody
test as a gold standard. This was the method used by Burke and his
colleagues and many HIV/AIDS experts, including David Ascher, believe
this data shows the false-positive rate of the HIV antibody tests to be
1/1,000,000 (Weiss & Thier, 1988; Ascher & Roberts, 1993).
According to Mulder and colleagues, their "HIV testing algorithm had a
sensitivity and specificity of close to 100%". Mulder's algorithm (Nunn
et al., 1993) is a far less substantial version of Burke's algorithm
and, like Burke's, uses the Western blot as a gold standard. For them,
the true serostatus depends on repeating two different ELISAs until they
are concordant, an outcome which could eventuate by making the same
mistake twice. A positive ELISA followed by a positive WB is also
regarded as proof of HIV infection. However, it is not possible to
determine the specificity of an HIV antibody test by repeating the test,
or using combinations of the same and other antibody tests as Burke and
Mulder and many others have done. According to Philip Mortimer, director
of the Virus Reference Laboratory of the Public Health Laboratory
Service, London, UK: "Diagnosis of HIV infection is based almost
entirely on detection of antibodies to HIV, but there can be misleading
cross-reactions between HIV-1 antigens and antibodies formed against
other antigens, and these may lead to false-positive reactions. Thus, it
may be impossible to relate an antibody response specifically to HIV-1
infection. In the presence of clinical and/or epidemiological features
of HIV-1 infection there is often little doubt, but anti-HIV-1 may still
be due to infection with related retroviruses (e.g. HIV-2) which, though
also associated with AIDS, are different viruses" [italics ours]
(Mortimer, 1989). Although Mortimer et al. (1985) as well as Gallo and
his colleagues (Weiss et al., 1985) used clinical and/or epidemiological
features" to determine the specificity of the HIV antibody tests, this
in scientifically invalid. The use of clinical and/or epidemiological
features is not a gold standard for the presence or absence of a
retrovirus and use of such a scheme creates many problems. For example,
because the vast majority of positive tests occur in individuals who are
asymptomatic, the vast majority of positive tests must be construed as
false-positives. Mulder et al had 377 individuals with a positive test.
Of these, 89 died within 2 years. Although not stated, we can assume
that many of the remaining HIV positive cases were asymptomatic and
thus, according to Mortimer, all these individuals had false-positive
tests. Of the 73 adults who died, only 5 had "AIDS"! the other 68 died
of unlisted causes and if asymptomatic for "AIDS" must all be regarded
as false-positive results.

Epidemiological data show that AIDS patients in general and Africans
including healthy Africans have high levels of antibodies. For example,
United States data indicates that serum IgG levels are higher in HIV+
American Blacks (mean 2234 ñ 930 mg/dl) than in HIV+ Caucasians (mean
1601 ñ 520 mg/dl). Serum IgG levels are also higher in Black blood
donors (mean 1356 ñ 220 mg/dl) than in Caucasians (mean 1072 ñ 243
mg/dl) (Lucey et al., 1991). Thus, in these individuals with high level
of antibodies one must expect cross-reactions with HIV antigens to be
the rule rather than the exception. That this is the case is amply
demonstrated by the African evidence and in fact is accepted by the best
known expert on African HIV/AIDS. In 1986, Quinn, Mann, Curran and Piot
wrote, in Africa "...serodiagnosis is complicated by the need for
confirmatory testing because of the presence of possible cross-reacting
antibodies" (Quinn et al., 1986). One year earlier Biggar stated that
"...reactivity in both ELISA and Western blot analysis may be
non-specific in Africans...the cause of the non-specificity needs to be
clarified in order to determine how they might affect the
seroepidemiology of retroviruses in areas other than Africa, such as the
Caribbean and Japan...Serological studies from Africa would need to be
re-evaluated with a more specific test before conclusions can be drawn"
(Biggar et al., 1985). Other eminent HIV/AIDS researchers including
Weiss accepted that African sera "may give a false-positive result on
direct binding assay systems, or on western blots" (Serwadda et al.,
1985). Not only are positive HIV antibody tests in Africa considered
proof of HIV infection, without any re-evaluation the criteria used for
a positive test are far less stringent than those used in the West.
However, this year no less a person than Myron Essex and his colleagues
presented unambiguous evidence that both ELISA and WB may not be
specific in Africa. Essex and his colleagues reported that "...leprosy
patients and their contacts show an unexpectedly high rate of
false-positive reactivity of HIV-1 proteins on both WB and ELISA". The
cross-reactivity was found to be caused by antibodies directed against
two major carbohydrate-containing M. leprae antigens--phenolic
glycolipid I and especially lipoarabinomannan, an arabinose-containing
lipopolysaccharide which is also present in M. tuberculosis and other
mycobacteria. They warned, "ELISA and WB may not be sufficient for HIV
diagnosis in AIDS-endemic areas of Central Africa where the prevalence
of mycobacterial diseases is quite high" (Kashala et al., 1994).
Cross-reactivity of antibodies to mannans with "HIV proteins" was also
reported by Muller and colleagues who found, "Polyclonal antibodies to
mannan from yeast also recognize the carbohydrate structure of gp120 of
the AIDS virus" (Muller et al., 1990). Others have "shown that normal
human serum contains antibodies capable of recognizing the carbohydrate
moiety of the HIV envelope glycoproteins", gp41, gp120 and gp160
(Tomiyama et al., 1991). In 1986, Mann and colleagues reported that in a
tuberculosis santitorium in Kinshasa, Zaire, half of the suspected
pulmonary cases, one third of the confirmed cases and two thirds of the
confirmed extra-pulmonary cases had a positive HIV Western blot antibody
test (Nzilambi et al., 1986). Tuberculosis (TB), the cause of which is a
mycobacterium, is endemic in Africa. Of the 661 million people in
sub-Saharan Africa, 2-3 million have active TB with an annual mortality
of 790,000. Despite this and the fact that in adults, "HIV infection"
usually follows TB infection, TB has now become an AIDS defining
illness, indeed 30-50% of African "AIDS" deaths are from TB. It is of
great significance that although neither the Mulder paper nor the
commentary on it elaborated on the causes of death in the 5 "AIDS"
cases, the authors of the latter wrote, "More information is needed to
clarify how many of the excess deaths could have been delayed through
optimum medical prevention and therapy of such HIV-associated illnesses
as tuberculosis, other pneumonias, and diarrhoeal disease". However,
since:

1. Tuberculosis has existed in Africa for many generations;

2. According to Essex, in patients with tuberculosis, positive HIV
antibody tests may be false-positives; the most one can conclude from
the African antibody tests is that the finding of a positive test
indicates an underlying abnormal propensity to develop a number of
illnesses, some of which may prove fatal. A positive "HIV antibody"
test is no more than a non-specific marker for this proclivity.

Thus, those "who will not even accept that antibody to HIV indicates
infection with the virus" have no need to postulate a "curious" or even
a novel explanation for the relationship between "a positive HIV
antibody test" and AIDS, or between positive HIV serology and mortality.
In fact, Mulder's data does nothing more than prove their predictions
(Papadopulos-Eleopulos et al., 1993a). Indeed, non-specific
antigen/antibody reactions are frequently exploited in clinical
practice. For example:

1. Antibodies to an extract of ox heart (cardiolipin) predict the
development of syphilis, including death from syphilis, but such
patients are not infected with ox heart and ox heart is not the cause
of syphilis.

2. Patients with infectious mononucleosis develop antibodies that
react with sheep and horse red blood cells. However, neither sheep nor
horse red blood cells are not present in these patients and they are
not the cause of the disorder.

HIV and AIDS

In 1984, in the first ever published paper describing HIV antibody
testing of Africans, Montagnier and his colleagues wrote, "The
prediction that a single infectious agent is at the origin of AIDS
implies that all those with proven AIDS show signs of infection"
(Brun-Vezinet et al., 1984). The presence of HIV in all AIDS patients is
a necessary condition but is not sufficient proof that the virus is the
cause of AIDS. Correlation is not proof of causation (Duesberg, 1989).
Ninety eight percent of haemophiliacs with AIDS test positive for the
presence of hepatitis B virus (Brenner et al., 1991), in fact hepatitis
B virus (HBV) seropositivity is a predictor for HIV seropositivity, but
no one claims that HBV is the cause of AIDS. No such degree of
correlation exists between AIDS and HIV seropositivity in Africa. In one
study, 83% of patients with suspected AIDS were HIV positive, but so
were 44% with malaria, 97% with herpes zoster, 43% with pneumonia, 67%
with amoebic dysentery and 41% with carcinoma. In the other study, 42%
of women with recurrent abortions, 67% with vaginal ulcerations and 33%
with haemorrhoids had a positive HIV antibody test. While the Bangui
AIDS definition had a positive predictive value for HIV seropositivity
of 62% in one of the studies and 83% in the other, in the same studies
the positive predictive value of amenorrhoea was 42% and 89%
respectively (Widy-Wirski et al., 1988; Strecker et al., 1993).

One of the principal major signs of the Bangui definition is loss of
body weight. However, in a study of Rwandan women over a 24 months
period beginning in 1988, it was reported that nutritional status
assessed by loss of body weight "was a significant predictor of eventual
HIV seroconversion. Subsequent seroconvertors lost an average of 1.5 kg
during the six months of the study compared with 1.0-Kg gain (p=0.001)
for nonconvertors. Nine of 27 (33%) seroconvertors, compared with one of
44 (2%) controls, lost at least 5Kg in the 6-month period beginning 1
year before their seroconversion...In addition to those findings for
measured weight loss during follow-up, reported weight loss before
enrolment was also a risk factor for subsequent seroconversion" (Moore
et al., 1993). In other words, this study found that weight loss
preceded HIV seroconversion by many months or even years. According to
Myron Essex, "The more medical scientists research the AIDS epidemic in
Africa, the more confusing the picture becomes...Among 37 people in
Ivory Coast, West Africa, with symptoms of AIDS, as defined by the World
Health Organization, 13 [35%] did not appear to have antibodies to HIV-1
or HIV-2, the second AIDS virus discovered more recently. A similar
study in Sengal uncovered 16 of 44 [36%] patients with AIDS, who again
showed no sign of infection with either virus" (New Scientist 18/2/88
page 27). Thus the HIV hypothesis of AIDS does not satisfy even the most
fundamental criterion for proof of an aetiologic agent. More extensive,
and thoroughly referenced critiques of its numerous deficiencies can be
found in (Duesberg, 1992; Papadopulos-Eleopulos et al., 1992a, 1992b,
1993a, 1993b, 1994).

Heterosexual Transmission

"To evaluate acquired immunodeficiency syndrome (AIDS) in central
Africa a prospective study was done in Kigali, Rwanda, where Kaposi's
sarcoma (KS) is endemic". The study was conducted by researchers from
Belgium, the Netherlands and Rwanda (Van De Perre et al., 1984). In
1983, these workers "sent a questionnaire to all clinicians at the
Centre Hospitalier de Kigali asking them to make a special note over a 4
week period of new patients who had clinical evidence of opportunistic
infection (OI) and/or generalised or multifocal Kaposi's sarcoma (KS) or
who had the AIDS prodrome. The prodrome [patients with the prodrome were
ultimately classified as AIDS patients] was defined by at least two of
the following: loss of more than 10% body weight, diarrhoea for at least
2 months with no pathogen isolated, chronic fever of unknown origin
lasting for at least 2 months, and generalised lymphadenopathy
consisting of palpable lymph nodes larger than 1 cm at two or more
extrainguinal sites for more than 3 months...Subsequently, immunological
evaluations were done in Kigali, after which we retained as having AIDS
or probable AIDS patients presenting with the above clinical features
provided they also had a decreased ratio of helper/inducer to
suppressor/cytotoxic T cells", that is a decreased T4/T8 ratio. They
found 26 such patients (17 males and 9 females), two of which were
children. "The 24 adult patients denied bisexuality or homosexuality or
intravenous drug use". Discussing their findings the authors wrote "The
study confirms that AIDS exists in Rwanda, a central African country
east of Zaire. The detection of 26 AIDS patients in a short period
supports that AIDS may be a public health problem in central
Africa...Characteristically, African AIDS affects women as well as men,
a pattern very different from the sex ratio (15:1) described in the
chronic form of KS that has for many years been seen in central
Africa...The low sex ratio suggests that heterosexual contact in the
most frequent mode of transmission in central Africa".

In the same year and month, researchers from Belgium, Zaire, and the
USA including the CDC, searched for AIDS in Zaire. The authors stated
that "Because of limited diagnostic facilities we used a case definition
which included clinical features of AIDS and the immunological
characteristics of low T helper cell counts and low helper to suppressor
ratios which have been hallmarks of AIDS. We believe that this
combination strengthens the case definition in an area where severe
infectious diseases abound, often going undiagnosed". During a three
week period they identified 38 such patients. Ten patients had "Chronic
mucocutaneous HSV [herpes simplex virus] infection", 14 bilateral
interstitial pneumonia "with severe dyspnoea, unresponsive to
antibiotics or tuberculostatics", 31 oral and/or oesophageal candidiasis
and 6 had disseminated KS. Regarding the latter they wrote "Since KS has
long been endemic in Zaire, only patients with fulminant KS were
included". Discussing their findings they wrote: "Two important
differences between AIDS in Zaire and the disease in patients of
European or American origin merit discussion-- namely, the sex
distribution and apparent lack of risk factors among patients in
Zaire...The essentially equal proportions of males and females would
require that transmission occurs both male to female and female to male,
since one-direction transmission would soon result in an imbalance in
the ratio" (Piot et al., 1984).

In 1984, sera from 37 out of the 38 patients who were diagnosed in
Kinshasha in October 1984 were tested for HIV antibodies by Montagnier
and 19 of his associates including researchers from the CDC. The sera
were tested by ELISA and followed by a RIPA (radioimmunoprecipitation
assay, similar to the Western blot). The latter was considered positive
if a p24 band was present. The p41 band and also a 84-kD band were not
considered diagnostic because "The 43-kD [p41] band and the 84-kD band
are cellular contaminants that are immunoprecipitated in all the tested
sera", from both patients and controls. (Yet today, in Africa, the p41
band on its own is considered to represent a positive WB and thus proof
of HIV infection). Thirty two (88%) patients were positive by both
tests. So were six out of 26 (23%) controls. (Brun-Vezinet et al.,
1984). However: (a) with the exception of a few other reports from
Africa (see below) no such correlation between ELISA and WB has ever
been reported. For example, Burke and his colleagues tested 1.2 million
healthy American military recruits and found that of 6000 individuals
with two consecutive positive ELISAs, only 2000 subsequently had a
positive Western blot (Burke et al., 1988). In Russia, in 1991, of
30,000 positive screening ELISAs, only 66 were Western blot positive
(Voevodin, 1992); (b) since 1987, nobody in the world with the possible
exception of Montagnier, considers the p24 band proof of HIV infection,
not even in Africa.

In July 1984, the research groups who reported the first 38 cases of
AIDS from Kinshasa started a new study in the same city. During an 8
month period they had "565 suspected AIDS cases", that is, they had 565
cases which satisfied "At least one of the following three clinical
criteria: (a) A syndrome with profound weight loss (> 10% of normal
body weight) plus either chronic diarrhoea (lasting at least 2 mo) or
chronic fever and asthenia (lasting 1 + mo); (b) An opportunistic
infection included in the Centers for Disease Control definition of AIDS
(restricted resources limited recognized opportunistic infections to
candidal esophagitis, cryptococcal meningitis and chronic ulcerated
herpes infection; and/or (c) Disseminated Kaposi's sarcoma, with
histopathologic evidence of visceral invasion". Of the 565 patients, 332
(58.8%) were found to have a positive HIV antibody test, and because of
this were considered to be confirmed AIDS cases. "A specimen was
considered positive for antibody to HTLV-III if it was repeatedly
reactive on two separate ELISA assays ...The male-female ratio was
1:1.1. Men with AIDS were significantly older than women... Nearly half
of all patients (145) were not married... Women with AIDS more likely
than men with AIDS to be unmarried". Commenting on their results the
authors stated:

"Several epidemiologic features of AIDS in Kinshasa should be noted.
A nearly equal sex distribution of cases has now been demonstrated in
this large series. This age distribution by sex, including a lower mean
age for female patients, is typical of sexually transmitted diseases.
However, interpreting surveillance data on possible means of exposure to
AIDS is difficult. For example, the finding that 61% of women with AIDS
are unmarried has been cited to support theories of heterosexual
transmission. However, 61% of nearly 933 women working at Mama Yemo
Hospital are also unmarried" (Mann et al., 1986).

Like Montagnier and the CDC, Gallo and his associates also tested
Africans for HIV antibodies. Of 53 patients with AIDS, including the
first 26 patients reported from Rwanda, "46 (87%) tested positive...67
(80%) of 84 prostitutes [without any clinical symptoms] and five (12.5%)
of 40 and eight (15.5%) of 51 healthy controls and blood donors,
respectively", also tested positive. "All blood donors were of good
socioeconomic status". Sera which had one positive ELISA were considered
as proof for HIV infection. Sera which had a borderline ELISA were
further tested with the WB. In the WB, "serum samples possessing
reactivity to HTLV-III p41 and/or p24 were scored positive. Gallo and
his associates concluded, "In Central Africa, as previously noted, the
occurrence of the syndrome in young to middle-aged men and women
suggests that heterosexual contact is probably the predominant mode of
transmission of the AIDS agent. Furthermore, among the 24 adults with
AIDS that we saw in Rwanda, 12 of the 17 men had contact with
prostitutes, and three of seven women were prostitutes" (Clumeck et al.,
1985). The claims in the above studies that: (a) Africans have AIDS; (b)
In Africa "Homosexuality, intravenous drug use and blood transfusions
did not appear to be risk factors"; (c) an approximately equal number of
male and females have AIDS, as well as a positive HIV antibody test; are
interpreted as proof that in Africa, HIV and AIDS is heterosexually
transmitted. Indeed, the perceived heterosexual spread of AIDS in Africa
underlies the belief that HIV and AIDS will eventually overtake the
West. But, "The mere absence of data to the contrary does not by itself
make the opposite assertion true; if it did, science would be a much
simpler thing. While it is true that in Africa the incidence of AIDS and
infection with [HIV] is nearly equal among men and women, we ought not
automatically assume that heterosexual transmission of the AIDS virus is
likely here...parasitic disease has been found repeatedly to be a risk
factor for seropositivity to the AIDS virus or AIDS itself in Africa and
Venezuela" (Pearce, 1986).

Nancy Padian and her colleagues who to date have most thoroughly
investigated heterosexual transmission of HIV/AIDS wrote: "We question
whether the ratio of male-to-female cases in Africa necessarily supports
the hypothesis that AIDS is primarily spread in Africa by bidirectional
heterosexual transmission" (Padian & Pickering, 1986). The fact that
equal numbers of men and women have AIDS or antibodies to HIV does not
prove that AIDS is heterosexually spread. Many diseases such as
influenza, pneumonia, tuberculosis and appendicitis have an equal sex
distribution but this is not construed as proof of heterosexual
transmission. To prove that AIDS is spread by sexual activity one must
study a large number of index cases, isolate HIV, prove it is the cause
of AIDS, trace the sexual contacts of these cases and then isolate the
same agent. To date, no reliable data of this type has ever been
presented either in Africa, or anywhere else. In fact, according to Dr.
Harry Haverkos from the US National Institute on Drug Abuse, "Sexual
contact tracing, the standard practice in public health to combat such
sexually transmitted diseases as gonorrhoea and syphilis, has been
avoided for tracing of HIV-infected persons. Health department personnel
are concerned about possible discrimination associated with AIDS, plus
the fact that there is no cure for the disease" (Haverkos & Edelman,
1988). As far as Africa is concerned, one must note that "AIDS patients
reported to the CDC are classified as HT [heterosexual] if they (1)
report heterosexual contact with a person with HIV infection or at
increased risk for HIV infection (US-born) or (2) were born in countries
where HT is a major route of transmission (non-US born)" (Chamberland et
al., 1988). This means that a man/woman born in Africa can be said to
have acquired AIDS by heterosexual contact even if his/her partner were
not proven to have "HIV infection", or even if he/she never had sexual
intercourse. Given the fact that the best known HIV/AIDS experts on
African AIDS admit that (a) what is known as AIDS in Africa has been
present for centuries and was equally common in men and women; (b) a
positive HIV antibody test may not be due to HIV antibodies but to the
presence of antibodies formed in response to malaria, tuberculosis,
leprosy and many parasitic diseases; one would predict that in Africa an
equal number of men and women will have "AIDS" and positive antibody
tests. To explain these observations one has no need to invoke the
activity of a virus called HIV. In fact, the theory that AIDS in Africa
is transmitted heterosexually creates more problems than it solves.

In 1986, Gallo and his colleagues wrote, "We found no evidence that
other [than receptive anal intercourse] forms of sexual activity,
contribute to the risk" of HIV seroconversion (Stevens et al., 1986). In
the West, the largest (thousands of cases) and most judiciously
conducted prospective epidemiological studies such as the Multicenter
AIDS Cohort Study (Kingsley et al., 1987) have proven beyond all
reasonable doubt that in gay men the only significant sexual act related
to becoming HIV antibody positive and progressing to AIDS is receptive
anal intercourse. A minority of the studies also report cases which
suggest transmission by passive orogenital sexual activity (Caceres
& van Griensven, 1994). Similarly, the largest and best conducted
studies in heterosexuals including the European Study Group (1989) have
also shown that for women, the only practice leading to an increased
risk of becoming HIV antibody positive is anal intercourse. Therefore,
in non-African countries the only risk factor for the acquisition of HIV
antibodies is anal intercourse in the passive partner (male or female),
and if the only cause for the development of HIV antibodies is HIV
infection then one must conclude that in non-African countries HIV is
unidirectionally sexually transmitted. Thus, at least in non-African
countries "HIV", like pregnancy, can only be acquired by the passive
sexual partner and cannot be transmitted to the active partner. The
unidirectional transmission of "HIV" observed in the West is further
supported by Nancy Padian's prospective study of heterosexual couples
where, from a cohort recruited from 1985 to March 1991 involving 72 male
partners of HIV infected women, there was "one probable instance" of
female-to-male transmission (Padian et al., 1991). In the whole history
of Medicine there has never been an example of a sexually transmitted
disease which is spread unidirectionally, and certainly not one that is
spread unidirectionally in one country and bidirectionally in another.
Indeed, given this and the other differences between AIDS in the West
and Africa it is necessary to postulate that HIV must indeed possess
features even more unique than those already attributed to it. Since the
only sexual behaviour risk factor for a gay man is receptive anal
intercourse, an exclusively active male partner is at no risk of
infection by his passive male partner. Yet if this same person travelled
to Africa and changed his sexual orientation, he would now be at risk of
infection by his passive female partner. Thus, HIV must be able to
distinguish an individual's sexual preference, gender and country of
residence.

More rationally, one might choose to agree with those African
physicians and scientists including Richard and Rosalind Chirimuuta
(Chirimuuta & Chirimuuta, 1987) who believe that immunosuppression
and certain symptoms and diseases which constitute African AIDS have
existed in Africa since time immemorial. According to Professor P.A.K.
Addy, Head of Clinical Microbiology at the University of Science and
Technology in Kumasi, Ghana "Europeans and Americans came to Africa with
prejudiced minds, so they are seeing what they wanted to see...I've
known for a long time that Aids is not a crisis in Africa as the world
is being made to understand. But in Africa it is very difficult to stick
your neck out and say certain things. The West came out with those
frightening statistics on Aids in Africa because it was unaware of
certain social and clinical conditions. In most of Africa, infectious
diseases, particularly parasitic infections, are common. And there are
other conditions that can easily compromise or affect one's immune
system" (Hodgkinson, 1994). In the words of Dr. Konotey-Ahulu from the
Cromwell Hospital in London, "Today, because of AIDS, it seems that
Africans are not allowed to die from these conditions [from which they
used to die before the AIDS era] any longer. ...Why do the world's media
appear to have conspired with some scientists to become so gratuitously
extravagant with the untruth?" (Konotey-Ahulu, 1987)

Acknowledgements

We would like to thank all our colleagues and
especially Richard Fox, Bruce Hedland-Thomas, David Causer, Gary James,
Udo Schulenk, Phil Johnson, John Lauritsen and the staff of the Royal
Perth Hospital Library and the clerical staff of the Department of
Medical Physics. We especially thank Charles Thomas and Neville
Hodgkinson for their help and motivating encouragement. Correspondence
Eleni Papadopulos-Eleopulos